Sunshine Recorder

In 1939, the first stand in the museum of the Royal College of Surgeons of England was dedicated to “foreign bodies”. This display might, at first, seem merely a cabinet of curiosities, but it so intrigued one Irish surgeon that he wrote an article on the topic. Published in the British Medical Journal, Ian Fraser’s text emphasised the importance of foreign body collections, claiming that these were not just oddities but told the “story of the human body”.

Many of the specimens described in Fraser’s article have since been lost, but other medical collections contain similar exhibits. Most famous perhaps is the Chevalier Jackson Foreign Body Collection at the College of Physicians of Philadelphia’s Mütter Museum in the USA, but such objects are also found in British pathology collections. Their location among human tissue specimens raises a number of interesting questions as to why (and how) they were collected, and how these displays were interpreted by collectors. Foreign bodies are often the only non-human specimens in pathology collections, indicating the ambiguous position they hold: a foreign body is not part of the human body, but neither can it be entirely separated from the place it was found.

The term foreign body, as applied to a substance of external origin present within the human body, seems to have entered medical language in the middle of the 18th century. The number of texts on the topic rapidly increased until 1880, followed by another peak around 1918. Often articles described techniques for the removal of such objects, the development of which certainly seems to have been a key point of interest in the early 20th century. Much of Chevalier Jackson’s work was dedicated to teaching his students the safe use of the newly available oesophagoscope and bronchoscope (Jackson developed his own in the 1890s). Before the introduction of such instruments, dangerous surgery was often required.

Around this time, radiography was also becoming recognised as an important new diagnostic tool—one that cast new light on foreign bodies. In the UK, the first X-ray produced at the Royal London Hospital, in 1896, was of a foreign body (a needle in the foot of an elderly woman), and photographs of a toy bicycle in the oesophagus of a child, removed by Sir Hugh Rigby in 1906, were reproduced in the literary Strand magazine. Some doctors suggested that the X-ray was a useful tool to detect malingering (which self-inflicted injury might often be described as). In 1899, for example, The Lancet reported the case of a German soldier whose “Self-Inflicted Injuries [had been] Diagnosed by the Roentgen Rays”. The soldier claimed to have been bitten by a horse: however, an X-ray revealed five needles in the wound. Locating foreign bodies thus became associated with concern over the economic consequences of feigned disease.

Yet this does not, in itself, explain the existence of foreign body collections or, indeed, the interest in reproducing X-rays of these items. In the Strand magazine, Rigby’s photograph became a curious artwork, the odd shape of the foreign body as significant as the process of removal. Surgeons often meticulously ordered the items they collected, especially when large numbers were removed from the same individual. Although often accompanied by notes and X-rays, foreign body specimens thus hint at more than either the original ingestion or removal. The objects themselves might even be considered to have anatomical and physiological interest. At times, the foreign body could reveal structures of the human body that were usually hidden. Trichobezoars were often described as “hair casts of the stomach” and, when J M Gage of the Royal Earlswood Institution wrote to the British Medical Journal in 1915, he included a photograph of the stomach-shaped mass of hair, tape, and bootlaces that he had removed from a patient. Gage noted that such an image would be interesting for his colleagues since “so much controversy has been raised lately regarding the shape of the stomach”.